Head and Neck Cancer

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MO_33_2770 - Decreasing Utilization of Concurrent Chemotherapy in Human Papillomavirus-Positive Oropharyngeal Cancer: Analysis of National Patterns of Care

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Decreasing Utilization of Concurrent Chemotherapy in Human Papillomavirus-Positive Oropharyngeal Cancer: Analysis of National Patterns of Care
R. Li1, D. Akhavan1, S. Sampath1, N. L. Vora1, E. Maghami2, T. Gernon2, R. Kang2, E. Massarelli3, and A. Amini1; 1Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, 2Department of Otolaryngology, City of Hope National Medical Center, Duarte, CA, 3Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA

Purpose/Objective(s): Human papillomavirus-associated (HPV+) oropharyngeal cancers are associated with more favorable survival outcomes. Ongoing trials are investigating treatment de-escalation approaches involving omission of concurrent chemotherapy, but results are not yet available. We thus analyzed trends of concurrent chemotherapy use with definitive and adjuvant radiation.

Materials/Methods: Patients with non-metastatic HPV+ squamous cell carcinoma of the oropharynx diagnosed from 2010 to 2015 were identified using the National Cancer Database. AJCC 7th edition staging was used. Two separate cohorts were analyzed: 1) stage III-IVB patients receiving radiation therapy (RT) alone or chemoradiation (CRT) and 2) stage I-IVB patients receiving definitive surgery. Logistic regression was used to assess predictors of chemotherapy utilization. Age, comorbidity score, stage, insurance type, facility type, and year of diagnosis were included as covariates. Pathologic extracapsular extension (ECE), use of nodal dissection, and surgical margin status were additional covariates in the adjuvant cohort.

Results: In the definitive cohort, we identified 5210 patients with stage III-IVB HPV+ cancer, of which 4873 patients (93.4%) received CRT and 368 patients (6.6%) received RT alone. The usage of CRT did not significantly change from 2010-2015 (p=0.478). On multivariate analysis, there was no significant association between year of diagnosis and chemotherapy use (odds ratio [OR] 1.04; 95% confidence interval [CI] 0.97-1.12; p=0.354). In the adjuvant cohort, we identified 4,754 patients treated with upfront surgery, of which 2782 patients (58.5%) received adjuvant CRT, 1168 patients (24.6%) adjuvant RT, and 804 received surgery alone (16.9%). Usage of combined CRT declined from 65.0% in 2010 to 53.3% in 2015 (p=0.002). Logistic regression showed that year of diagnosis remained significantly associated with chemotherapy use after adjustment for covariates including ECE and margin status (OR 0.93; 95% CI 0.89-0.98; p=0.004). In a subset of 1682 patients with positive margins and/or ECE, CRT declined from 78.7% in 2010 to 71.7% in 2015 (p=0.038).

Conclusion: We found that rates of concurrent chemotherapy utilization with adjuvant RT declined from 2010 to 2015 in HPV+ oropharyngeal cancers, despite absence of randomized evidence. Rates of concurrent chemotherapy with definitive RT did not significantly change. Data from clinical trials are urgently needed to determine whether omission of chemotherapy is associated with a survival detriment for HPV+ cancers. Table 1. Usage of chemotherapy in the adjuvant setting for HPV-positive oropharynx patients
Year Surgery alone (n=804) Surgery + RT (n=1168) Surgery + CRT (n=2782)
2010 48 (12.3%) 89 (22.8%) 254 (65.0%)
2011 94 (15.6%) 144 (23.9%) 365 (60.5%)
2012 132 (17.2%) 179 (23.3%) 458 (59.6%)
2013 146 (16.1%) 203 (22.3%) 560 (61.6%)
2014 179 (17.4%) 266 (25.9%) 584 (56.8%)
2015 205 (19.5%) 287 (27.3%) 561 (53.3%)

Author Disclosure: R. Li: None. D. Akhavan: None. N.L. Vora: None. R. Kang: None. E. Massarelli: None. A. Amini: None.

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